Healthcare Provider Details

I. General information

NPI: 1104962638
Provider Name (Legal Business Name): ROBERT ARNOLD NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30150 SO HWY ONE
GUALALA CA
95445
US

IV. Provider business mailing address

30150 SOUTH HWY ONE
GUALALA CA
95445
US

V. Phone/Fax

Practice location:
  • Phone: 707-884-3207
  • Fax:
Mailing address:
  • Phone: 707-884-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG11812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: